重组组织型纤溶酶原激活剂治疗急性脑梗死30例

Efficacy of recombinant tissue plasminogen activator in treatment of acute ischemic stroke

目的:观察重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗超急性期脑梗死的临床疗效。方法:将2010年1月至2011年5月深圳市龙岗区第二人民医院收治的50例超急性期脑梗死患者,分为研究组(30例)和对照组(20例)。对照组常规应用抗血小板聚集药物、调脂稳定斑块、抗脑缺血,同时控制血压和血糖等;研究组在常规治疗的基础上,应用rt-PA静脉溶栓,剂量为0.9 mg/kg,最大剂量90 mg。治疗前后进行美国国立卫生院神经功能缺失(NIHSS)评分、改良Rankin评分和日常生活能力Barthal指数(BI)评分,并观察疗效、不良反应和预后。结果:对照组患者治疗后90 d,NIHSS评分由(11.85±1.30)分下降为(8.92±4.53)分,改良.Rankin评分临床转归良好7例(35%);脑出血1例,症状性出血转化率5%;死亡2例,病死率10%。研究组患者治疗后90 d,NIHSS评分由(11.80±2.23)分下降为(5.38±3.77)分,较对照组明显下降(P=0.008);改良Rankin评分临床转归良好16例(53%);出血转化8例,其中1例为症状性出血转化,症状性出血转化率为3%;死亡3例,病死率10%。结论:早期rt-PA静脉溶栓治疗发病4.5 h内的急性脑梗死安全有效,并可以改善远期预后。

Objective： To evaluate the efficacy of recombinant tissue plasminogen activator （rt-PA） in treatment of acute ischemic stroke. Methods： 50 patients with severe acute ischemic stroke, registered Second People＇s Hospital of Longgan District, Shenzhen, between January 2010 and May 2011, were randomized to two groups ： the study group （ n = 30 ） and the control group （ n = 20 ）. The control group received conventional therapy with antiplatelets, plaque modifiers as well as measures to improve cerebral ischemia and to control the blood pressure and sugar. In addition to the therapy given in the control group, the study group received treatment with rt-PA in dose of 0.9mg/kg up to a maximum of 90mg. At baseline and after treatment, the patients were evaluated for neurological deficit by using the NIHSS and for daily functional by using the Barthal index. The therapeutic efficacy, adverse events and prognosis were also investigated among the patients. Results ： Compared with baseline, there was a NIHSS decline from 11.85 ± 1.30 to 8.92 ± 4.53 in the control group vs 11.80 ± 2.23 to 5.38 ± 3.77 in the study group （P = 0. 008 between groups） on day 90. By Rankin scores, there were 7 cases （35%） with favorable clinical outcomes in the control group compared with 16 （53%） in the study group. There was 1 case of cerebral hemorrhage （rate of symptomatic hemorrhagic transformation： 5% ） and 2 death cases （case fatality 10% ） in the control group, compared with 8 cases of hemorrhagic transformation （ symptomatic in 1 case, rate of symptomatic hemorrhagic transformation： 3% ） and 3death cases （case fatality 10% ） in the study group. Conclusion： Recombinant tissue plasminogen activator is safe, effective and with favorable long-term outcomes for treatment of acute ischemic stroke within 4.5 h of symptom onset.